Early Effect of Intravitreal Faricimab on Hard Exudates in Diabetic Macular Oedema.

INTRODUCTION: Intravitreal faricimab is the first bispecific antibody to target vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2). In the study reported here, we examined the early effect of intravitreal faricimab on hard exudates (HEs) in patients with diabetic macular oedema (DMO). METHODS: Consecutive patients who were initiated on faricimab for centre-involving DMO associated with HEs between August 2022 and July 2023 were reviewed. Areas of HE were confirmed on colour fundus photographs taken at initiation of therapy and at the 6-month follow-up. ImageJ software was used for semi-automated segmentation and measurement of the HE area within the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Demographic data, including age, gender and ethnicity, as well as best-corrected visual acuity (BCVA), central retinal thickness (CRT) and macular volume (MV) were recorded. RESULTS: A total of 19 eyes from 16 patients were included in the study. Mean age of the cohort was 60.6 (range 49-71) years; ten eyes (53%) were treatment naïve. The median total HE area was reduced from 0.15 (interquartile range [IQR] 0.04-0.30) mm2 to 0.10 (IQR 0.07-0.24) mm2 by the 6-month follow-up. A greater reduction in total HE area was observed in treatment-naïve eyes (- 0.14 mm2) compared with previously treated eyes (+ 0.05 mm2), despite the former having a higher median baseline value (0.25 [IQR 0.15-0.47] mm2 vs 0.05 [IQR 0.04-0.15] mm2). Mean BCVA improved from LogMAR 0.26 ± 0.22 to 0.18 ± 0.19 (p < 0.05), while mean CRT and MV reduced from 413 ± 108 to 340 ± 95 μm (p < 0.001) and from 10.03 ± 1.41 to 9.20 ± 1.17 mm3 (p < 0.0001), respectively. CONCLUSION: Intravitreal faricimab may be associated with reduction of HE area in DMO within 6 months of initiation, with greater effects in treatment-naïve eyes. Further studies with longer follow-up are warranted to determine the durability of HE resolution and its comparison to intravitreal steroids and other anti-VEGF agents.